Retroorbital pain

The most common ophthalmic signs were found on the macular region of the retina . Macular
haemorrhage (69%) and oedema (77%) made up the majority of the findings, often as a combination.
These often presented as scattered blot and flame haemorrhages associated with perifoveal
telangiectasia. The next most common finding on ophthalmoscopy was retinal vasculitis (23%),
intermediate uveitis and posterior vitreous cells. Subconjunctival haemorrhage was an uncommon
finding occurring in only 3 eyes. Other less common findings include anterior uveitis and inflammatory
optic neuropathy
The onset of manifestations coinciding with the start of thrombocytopenia recovery correlates with
increased immunological response. An hypothesis about the pathogenesis of DHF, though proven true
in vivo, involves immune clearance by way of induction of cross-reactive T-cell memory, T-cell
proliferation, and recognition of dengue viral antigens on infected monocytes by sensitized CD4+CD8
and CD4CD8+ cytotoxic T cells. This results in the release of cytokines with vasoactive and
procoagulant properties (interleukins, tumor necrosis factor, platelet-activating factor, and urokinase)
(17,18). Vasoactive and inflammatory mediators cause capillary leakage, which may form the basis for
macular edema and breakdown of the aqueous blood barrier, resulting in anterior uveitis and
periphlebitis. In the series reported by Lim et al., ocular complications were mainly confined to the
maculae (5). However, in our series the extent of involvement includes both the peripheral retina in
the posterior segment and the anterior segment (anterior uveitis), which suggests a more widespread
inflammatory process in the eye.
The onset of visual symptoms occurs on or close to the day of the lowest serum platelet level. Visual
recovery, in the form of improvement of signs and symptoms, usuallycorresponds to improving platelet
levels but may take several weeks to reach a steady state. Most patients report residual visual
impairment in the form of central or paracentral scotoma.
Treatment
The use of systemic steroids in 2 patients did not appear to aggravate the visual complications or the
systemic dengue infection. This finding is supportive of an inflammatory or immune-mediated
pathophysiology after acute dengue infections. Visual symptoms and visual acuity recovered in the
same manner and speed as in patients with milder, untreated cases. However, like the other patients,
both also described a persistent central scotoma despite normal functional Snellen visual acuities.
However, we were not able to draw any statistical conclusions on the efficacy of treatment outcomes.